Objective To examine how consumer satisfaction ratings differ between mental health providers and to determine if comparison of ratings between providers is biased by differences in survey response rates or characteristics of consumers served. Methods Secondary analysis of routinely mailed consumer satisfaction surveys in a mixed-model prepaid health plan. Satisfaction survey data were linked to computerized record data regarding consumers’ demographic (age, sex, type of insurance coverage) and clinical (primary diagnosis, initial vs. return visit) characteristics. Statistical models examined both probability of returning the mailed satisfaction survey and (among those returning surveys) probability of giving an “Excellent” satisfaction rating. Variability in consumer characteristics was decomposed into within-provider effects and between-provider effects. Results Overall response rate was 33.8%, and 49.9% of those responding reported “Excellent” satisfaction. Neither response rate nor satisfaction rating was related to primary diagnosis. Within the practices of individual providers, both response rate and receiving an “Excellent” rating were significantly associated with female sex, older age, longer enrollment in the health plan, and making a return (vs. initial) visit. Analyses of between-provider effects, however, found that only having a higher proportion of return visitors was significantly associated with higher response rates and higher satisfaction ratings. Conclusions There is little evidence that differences in response rate or differences in consumers served bias comparison of satisfaction ratings between mental health providers. Bias might be greater in a setting with more heterogeneous consumers or providers. Returning consumers give higher ratings than first-time visitors, and analyses of satisfaction ratings may need to account for this difference. Extremely high or low ratings should be interpreted cautiously, especially for providers with a small number of surveys.

Patient satisfaction is increasingly becoming an important component of quality for behavioral health care systems. The following report describes Group Health Cooperative's Behavioral Health Services department experiences over a 5-year period in moving from uncertainty about the value of patient satisfaction and the ability to positively impact patient ratings to achieving a significant improvement in patient ratings of satisfaction with mental health care. In this process, the Behavioral Health Department developed a deeper understanding of patient requirements and improvement strategies which could impact these requirements. A description of the results achieved along with the role of quality improvement processes in understanding and improving patient satisfaction in mental health care is presented.

There was little evidence that differences in response rate or in consumers served biased comparison of satisfaction ratings between mental health providers. Bias might be greater in a setting with more heterogeneous consumers or providers. Returning consumers gave higher ratings than first-time visitors, and analyses of satisfaction ratings may need to account for this difference. Extremely high or low ratings should be interpreted cautiously, especially for providers with a small number of surveys.

This article addresses the role of personality assessment-specifically the Rorschach (Exner, 2002)-]in the context of the health care industry's increased focus on patient satisfaction. When providing psychotherapy, a challenge to providing patient-centered care turns on understanding and acting on the key aspects of the patient's personality that are crucial to forming an effective alliance. This article includes a description and examples of how personality assessment can enhance therapists' understanding of the ideational, affective, and self-control aspects of complicated patients' problem-solving styles. This enhanced understanding in turn can lead to improved therapeutic alliance between therapists and patients and to increased patient satisfaction with their care. How to provide feedback to the therapist also is addressed.

This article represents the history of primary care and behavioral health integration at Group Health Cooperative (GHC) over the last decade, and foreshadows probable futures for this work into the next decade. To build from a logical progression, the article responds to a series of questions: 1. Why integrate primary care and behavioral health? 2. What has been done so far and how well has it worked? 3. Keeping the end in mind, what's the idealized picture of integration for the future? 4. How to get from here to there? What will help or hinder the effort? and 5. Again, why make these efforts to integrate?